1. Political Analysis and Political Strategies

2. Political Analysis and Policy Development  All policy reforms, are profoundly political processes.  Policy developers should begin political analysis early in the policy cycle;  They shouldn't delay political analysis until after the policy has been developed.  Waiting to assess the political implications of a policy can lead to proposals that are not likely to be adopted.  The technical work of policy development and the political work of feasibility assessment need to occur at the same time.

3. Issue-attention Cycle  Issues come and go in political life as a matter of public attention, in what has been called the issue-attention cycle  The mass media play an important role in shaping this cycle of issues for public debate.  As stories become worn out and boring over time, the media have an incentive to find new, interesting topics to attract viewers and readers

4. Available Solutions and Agenda-Setting  The availability of proposed solutions also affects the definition of an issue.  This is usually an active process, and depends on the existence of a committed individual or organization.  In these situations, these agencies become policy entrepreneurs ; actors who seek to promote a particular issue and a particular solution

5. Crisis and Agenda-Setting  A crisis can provide an opportunity to place an issue on the policy agenda.  In some cases, policy entrepreneurs seek for years to introduce a particular policy reform, only when the right combination of crisis and political circumstances come together  Political cycles and timing also affect which issues get on a country’s policy agenda.  A new minister of health, for example, commonly seeks to define a new policy agenda shortly after entering office.

6. Window of Opportunity  Policy entrepreneurs not only must make their solution more attractive than alternative ones, but they have to make their problem more important than competing issues.  Political timing therefore is critical, since the window of opportunity for policy change is often limited and subject to unanticipated events  Policy entrepreneurs need to develop an understanding of when the window of opportunity is open, how long it is likely to remain open, and how to squeeze their policy changes through the window quickly—before it slams shut again.

7. Three Stream Model  Political scientist John Kingdon (1995) has argued that the best chances for successful policy change occur when three streams of events come together: 1.The objective situation—the problem stream, 2.The availability of a possible solution—the policy stream, and 3.The flow of political events—the political stream.  When these three streams converge, according to Kingdon’s theory of agenda-setting, some policy response is likely to result—although the response may not resolve the problem.

8. Agenda-Setting for Health Reform  Health reform advocates often organize a “change team” to manage the processes of policy design and adoption  They must devise an acceptable definition of the problem and a feasible proposal for the solution.  The change team requires not only technical capacity for policy design but also political capacity for policy mobilization of relevant groups and individuals.

9. The Change Team  An analysis of change teams in three Latin American cases of health reform (Chile, Colombia, and Mexico) found several common traits:  Ideological cohesiveness,  High technical skills,  Work in isolation,  Use of policy networks  While composed of technical people, who could formulate a new policy, they also needed to engage in bureaucratic battle with government agencies, manage the pressures from interest groups, navigate the legislative process of producing a new law, and initiate implementation of the reform.

10. 4 P Model of Political Analysis 1. Players: the set of individuals and groups who are involved in the reform process; 2. Power: the relative power of each player in the political game; 3. Position: the position taken by each player, including whether the player supports or opposes the policy 4. Perception: the public perception of the policy, including the definition of the problem and the solution, and the material and symbolic consequences for particular players.

11. Collective Action Dilemma  Systematic characteristics of the politics of health sector reform 1.Technical complexity/difficulty 2.Concentrated costs on well-organized groups 3.Dispersed benefits on non-organized groups  The combination of concentrated costs on well-organized groups and dispersed benefits on non-organized groups constitutes what is called a collective action dilemma.

12. Stakeholder Analysis  A basic building block in designing political strategies for reform is to perform a stakeholder analysis.  This consists of three stages. 1.First, identify the relevant groups and individuals. 2.Second, assess their political resources and their roles in the political structure, to determine their relative power for the policy question at hand. 3.Third, evaluate their current position on the proposed policy (including the intensity of their commitment) and their underlying interests.

13. Position map for major players in health reform in the Dominican Republic in 1995 High Support Medium Support Low Support Non- mobilized Low Opposition Medium Opposition High Opposition Office of Technical Cooperati on (for Health Reform) PresidentUniversitiesNon- Government al Organization s Private Cllnicians Dominican Medical Associati on International Developm ent Banks Partido de Liberacion Domnicana ChurchDominican Institute of Social Security Employers in the Organized Sector Secretary of Health Press Secretary of Health Bureaucrac y Beneficiaries National Health Commissi on Low Power: MedHigh

14. Political Analysis  Stakeholder analysis combines two distinct modes of analysis. 1.One is interest group analysis. This consists of understanding those social groups that are seeking to press the government in a particular direction. 2.The second mode of analysis examines bureaucratic politics, and is focused on the competition among agencies and individuals within government

15. Sources of Power and Influence TangibleIntangible MoneyInformation OrganizationAccess to leaders PeopleAccess to media VotesSymbols EquipmentLegitimacy OfficesSkills

16. Position and Commitment  A first step is to assess the group’s interests because interests do shape policy positions.  Anticipated economic consequences of a policy often determine political positions on that policy.  It is also important to examine the positions that the players have taken publicly  As part of this analysis, we also need to describe the intensity of each group’s current position on an issue  Developing effective political strategies requires an understanding of why the key groups are taking their positions.

17. Political Strategies for Reform  Position Strategies: Bargain to Change the Position of Players  Power Strategies: Distribute Power Resources to Strengthen Friends and Weaken Enemies  Player Strategies: Change the Number of Players, by Creating New Friends and Discouraging Foes  Perception Strategies: Change the Perception of the Problem and the solution.

18. Position Strategies  Change a specific element of the policy’s substance  Inter-issue exchanges  Threats as well as promises

19. Power Strategies  Give or lend money, staff, or facilities to groups that support the reform;  Provide information and education to supporters in order to increase their expertise;  Give allies expanded access to lobby key decision makers;  Provide allies with media time and attention in order to enhance their legitimacy; focus attention on their expertise, impartiality, national loyalty, and other positive social values.

20. Player Strategies  Mobilize players who are not yet organized and demobilize players who are already organized  Change the arena of decision-making

21. Perception Strategies  In some political systems, particularly those that are open and competitive, a public appeal through the media and to specific targeted groups can change the general perception of an issue.  This approach can be an effective political strategy for influencing bureaucratic and political leaders, as well as mass audiences.  Political strategies directed at perceptions seek to change how people think and talk about a policy problem, how the issue is defined and framed, and which values are at stake

22. Perception Strategies  Cast the emotional tone and energy in a positive instead of a negative direction.  Negotiation is a human process, filled with emotion as well as logic.  Negotiators, therefore, need to manage the emotional dimensions as well as the logical content, for success

23. Negotiation and Political Strategies  Negotiations are often successful when the issue is constructed in win-win terms rather than win-lose terms  Seek value-creating solutions, such that enough participants are willing to support the deal  Respond to the real interests of other parties, not to the positions they happen to take

24. Political Strategies and Ethics  Politics of health reform should not be approached solely as an instrumental or Machiavellian problem.  Health reformers need to consider the ethical dimensions of their political strategies, as well as how to get the policies they want.  Values shape the substantive content of health reform  But values also shape the processes for promoting the adoption of the health reform plan.

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